Transcript Document 7134764

Health Disparities in the LGBT
Elderly
Ethnogeriatrics Course Feb 2011
Katherine Breitenbach, APN
Charles Rhee, MD
Erika Sullivan, MS4
Megan Huisingh-Scheetz, MD, MPH
Case
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71 yo F presented to clinic to establish care.
PMH - Type 2 DM, HTN, HL, OA
Soc Hx –
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40 pyh tobacco, Remote etoh abuse?, No illicits
Lives alone in 3 flat bldg, paranoid about break-in’s
She is a “big spender” and has a “poor credit score,”
No children
Fxnl Hx –
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Missed paying bills,
Completed HS,
Transfers and mobility limited by knee and shoulder
OA
GDS – 3/15, MMSE – 29/30
Case
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MD referred to SW for counseling
for “anxiety” symptoms
Pt revealed to SW that she had
female sexual partners, denied
being lesbian.
Led to significant stress b/c of the
lack of community acceptance.
To date, MD and pt have never
discussed pt’s sexuality.
How might this issue affect her health?
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Risk factors
Lack of social support networks
POA and Living Will
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Social Isolation and loneliness
Psychological consequences
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State variation
Depression, Anxiety,
Mistrust/Confidentiality/Fear of Judgment
Government recognition of partner
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Medicare benefit
Defining Gender and Sexual
Orientation
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What is Gender: “A construct of biological
psychosocial, and cultural factors generaly used
to classify individuals as male or female.:
What is Transgender: “An inclusive term to
describe people who have gender identities,
expressions, or behaviors not traditionally
associated with their birth sex.”
What is sexual orientation: “Sexual orientation
encompasses more than sexual behavior, because
individuals may identify with a specific sexual
minority group without expressing those
behaviors.” In contrast, they may practice sexual
behaviors consistent with definitions of
homosexuality but not define themselves within
the terms gay, lesbian, or bisexual.
Mayer et al. (2008). Sexual identity and gender minority health: what we know and what needs to be done. American Journal of Public Health
98(6).
Decreased Access/Utilization of Health Care
services in the GLBT population
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Lack of utilization of
services out of fear of
judgement or
discrimination
Uninsured
“Heterosexism”
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Less preventative
measures,
decreased risk
reduction for
illness
Decreased
screening
Lack of population
based research
Leading Health Indicators among Sex and Gender Minorities: Healthy People
2010
Leading Health Indicators in the
General US Population
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Physical Activity
Overweight and Obesity
Tobacco Use
Substance Abuse
Responsible Sexual
Behavior
Mental Health
Injury and Violence
Environmental quality
Immunizations
Access to Care
Areas of Increased Concern for
Sexual and Gender Minorities
Caring for Lesbian and Bisexual Women:
Considerations for Clinicians
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Tobacco Abuse
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Only demographic whose smoking increases
with age
LBT women smoke 200% more than other
women**
Overweight and Obesity
Lower rates of Childbirth
Increased rates of Breast Cancer
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Screening for other CA is imperative, pap,
mammogram, colonoscopy all at appropriate
intervals
**Bye, L., Gruskin, E., Greenwood, G., Albright, V., and Krotki, K. The 2003 California Lesbian, Gays, Bisexuals, and
Transgender (LGBT) Tobacco Survey, Field Research Corporation, San Francisco, CA. 2004
Caring for Gay and Bisexual Men:
Considerations for Clinicians
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HIV/AIDS
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STD/STI
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Increased rates and recurrence of Syphilis
CDC reccomends annual screening
Hepatitis immunization
HPV  increased risk for anal CA
Substance Abuse
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42% of new HIV infections/year
s/e of drugs  HART therapy increases lipids
AIDS Dementia
Increased risk for unsafe sex behaviors
Eating and body image disorders
Caring for Transgender patients:
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MALE to FEMALE (MTF)
FEMALE to MALE (FTM)
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Prostate/Breast/Cervical CA screenings
still important aspect of care
Long term effects of hormone therapy
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Increased cardiovascular risk
Violence/Stigma
LGBT Demographics
http://www.communitymarketinginc.com/documents/temp/CMIIndex2011.pdf
LGBT Communities In US Cities
Heteronormative Behavior
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Attitude, language
and behavior which
stipulates that
heterosexuality is
“normal” and that all
other gender pairings
are “abnormal”
Assumptions about
sexual practice and
orientation can be
discriminatory and
prevent individuals
from accessing proper
health care
Interpersonal interactions
 Intended or unintended
persecution and
prejudice
Legislated nationally
 Local, state and federal
laws prohibiting same
sex unions
 Power of attorney and
next of kin
Health care
 Intake questionnaire
forms
 Sexual histories
Support and Resources for the
Patient and Provider
Healthcare provider
Religious/spiritual
Patient
Legal
Social
LGBT Healthcare Resources
Gay & Lesbian Medical Association (GLMA) http://www.glma.org
Comprehensive listing of healthcare resources for LGBT patients,
as well as for physicians seeking additional information on the
care of LGBT patients
Howard Brown Health Center - http://www.howardbrown.org
Chicago based LGBT health organization offering health care
services to the LGBT community as well as information regarding
services available throughout the the Chicago area
LGBT Healthcare Resources (cont)
The Body - The Complete HIV/AIDS Resources http://www.thebody.com
Extensive database on HIV/AIDS treatment, research, and
educational material for both patients and providers
The Ruth M. Rothstein Core Center http://www.corecenter.org
Integrated HIV/AIDS center in Chicago (Cook County
Hospital/Rush Hospital) offering medical treatment as well as
social services
Illinois Dept. of Public Health AIDS Drug Assistance Program
(ADAP) - http://www.idph.state.il.us/health/aids/adap.htm
LGBT Social Resources
Center on Halsted - http://www.centeronhalsted.org
Large Chicago-based LGBT community center offering a
wide variety of social activities, as well as multiple support
group meetings. Notably,
http://www.centeronhalsted.org/cohsage.html which
focuses on LGBT activities for individuals 55 or older.
National Resource Center on LGBT Aging http://www.lgbtagingcenter.org/
Relatively new website still in progress which will address
issues specific to geriatric LGBT populations
LGBT Social Resources (cont)
Chicago House - http://www.chicagohouse.org
Organization devoted to providing housing and support to
HIV positive patients who may be also impacted by
poverty, homelessness, mental illness, or substance abuse
Parents, Families, and Friends of Lesbians and Gays
(PFLAG) - http://www.pflagillinois.org/
National organization formed by LGBT allies with multiple
resources regarding issues such as coming out or
accepting a newly out family member
LGBT Religious Resources
Gaychurch.org -
http://www.gaychurch.org/Find_a_Church/united_states/
us_illinois.htm
Comprehensive listing of gay friendly churches
(Christian/Catholic) in the Chicago land area, organized by
location and denomination
Hebrew Union College / Institute for Judaism and
Sexual Orientation http://huc.edu/ijso/SynOrg/LGBT/list/
National listing of gay friendly synagogues
LGBT Legal Resources
Lambda Legal - http://www.lambdalegal.org
National organization with numerous resources including
information regarding LGBT specific medical-legal issues
such as visitation rights, POA, and discrimination
AIDS Legal Council of Chicago -
http://www.aidslegal.com/
Provides legal assistance and advocacy for people living
with HIV/AIDS on issues such as access to care
Interventions
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Provider / Staff Education
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Core competency and exposure during training
Get to know local resources
Understand the unique risks and challenges
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Clinical Encounter
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Social support, legal support services
Neutralize discussion and language
Routine
Confidentiality
Use patient preferred pronouns
Welcoming Environment
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Unisex bathrooms
Non-discrimination statement
http://www.qahc.org.au/files/shared/docs/GLMA_guide.pdf